Rising primary cesarean delivery rates and falling VBAC rates
strongly affect maternal mortality rates, both because of the
slight increase in maternal mortality after a cesarean, but also
because of increases in placenta previa and accreta after
multiple cesareans. The number of additional maternal deaths
per increase in cesarean sections in this analysis is similar to
but slightly higher than that of a previous model that projected
morbidity in the first pregnancy after a primary cesarean [25].
This is expected, due the additional future births modeled in
the present analysis, and serves to validate this model.
Additional model validation may come in the form of trending
both the rates of primary cesarean and maternal morbidity and
mortality in future years.